Provider Demographics
NPI:1760618581
Name:DR LEE CHIROPRACTIC & ACUPUNCTURE LTD.
Entity Type:Organization
Organization Name:DR LEE CHIROPRACTIC & ACUPUNCTURE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-375-6500
Mailing Address - Street 1:1283 E OGDEN AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4803
Mailing Address - Country:US
Mailing Address - Phone:630-355-4108
Mailing Address - Fax:630-355-4109
Practice Address - Street 1:1283 E OGDEN AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4803
Practice Address - Country:US
Practice Address - Phone:630-355-4108
Practice Address - Fax:630-355-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010871111N00000X
IL198-000759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2954Medicare PIN